State-wide surveillance of antibiotic resistance patterns and spa types of methicillin- resistant Staphylococcus aureus from blood cultures in North Rhine-Westphalia,

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State-wide surveillance of antibiotic resistance patterns and spa types of methicillin- resistant Staphylococcus aureus from blood cultures in North Rhine-Westphalia, 2011– 2013 C. Cuny, F. Layer, G. Werner, D. Harmsen, I. Daniels-Haardt, A. Jurke, A. Mellmann, W. Witte, R. Köck Clinical Microbiology and Infection Volume 21, Issue 8, Pages 750-757 (August 2015) DOI: 10.1016/j.cmi.2015.02.013 Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 1 Origin of methicillin-resistant Staphylococcus aureus (MRSA) isolates from cases of bacteraemia in North Rhine-Westphalia (2011–2013). Colours indicate the number of hospital beds per district. The number of isolates typed from the respective districts is indicated by the edge around the district code. Districts within the German federal state of North Rhine-Westphalia are designated according to the Nomenclature of Units for Territorial Statistics (NUTS) code ‘DEA’. From districts DEA 44 and 45, no MRSA isolates were typed. Map: ©d-maps.com; http://d-maps.com/carte.php?num_car=24031&lang=de. Clinical Microbiology and Infection 2015 21, 750-757DOI: (10.1016/j.cmi.2015.02.013) Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 2 Proportion of CC398 among methicillin-resistant Staphylococcus aureus (MRSA) from blood cultures in North Rhine-Westphalia (2011–2013). Colours indicate the proportion of MRSA CC398 on all MRSA isolates typed from the respective districts. Districts within the German federal state of North Rhine-Westphalia are designated according to the Nomenclature of Units for Territorial Statistics (NUTS) code ‘DEA’. From districts DEA 44 and 45, no MRSA isolates were typed. Pig densities in the districts are indicated according to data from Statistisches Bundesamt, https://www.destatis.de/. Map: ©d-maps.com; http://d-maps.com/carte.php?num_car=24031&lang=de. Clinical Microbiology and Infection 2015 21, 750-757DOI: (10.1016/j.cmi.2015.02.013) Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. S1 Distribution of resistance phenotypes among 1952 methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia isolates from the German federal state of North Rhine-Westphalia (2011–2013). Categorization into susceptible and resistant was done according to EUCAST clinical breakpoints v4.0 and MIC results based on broth microdilution. OXA (anti-staphylococcal β-lactams; oxacillin), MACRO (macrolides; erythromycin), LINC (lincosamides; clindamycin), AMINO (aminoglycosides; gentamicin), QUIN (fluoroquinolones; ciprofloxacin or moxifloxacin), RIFA (ansamycins; rifampicin), others (other rare phenotypes; all <1% of all isolates). Clinical Microbiology and Infection 2015 21, 750-757DOI: (10.1016/j.cmi.2015.02.013) Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions